WASHINGTON — There doesn't appear to be any difference in long-term cognitive function following coronary artery bypass graft or stenting.
This finding comes from an assessment of cognitive function at 6 years in 152 patients whose coronary artery disease (CAD) was treated with coronary artery bypass graft (CABG) and 92 patients whose CAD was treated with stents. Dr. Guy McKhann, professor of neurology and neuroscience at Johns Hopkins University, Baltimore, and his colleagues found that cognitive declines noticed after surgery are related to the presence of vascular disease. “The real attention should be on modifying risk factors.”
In terms of cognitive change over 6 years, there was minimal decline, but essentially these two groups were the same, Dr. McKhann reported at the annual meeting of the American Neurological Association. The average Mini-Mental State Examination (MMSE) score was 27.4 for the CABG group and 27.9 for the stent group. The average Center for Epidemiologic Studies-Depression (CES-D) scale score was 9.5 for the CABG group and 9.0 for the stent group.
The issue of long-term cognitive decline following coronary artery surgery is an important one, given that there continues to be uncertainty over the best approach to treat coronary artery disease. “This issue of late decline has gotten into this debate” and is used as an argument for stenting rather than surgery, he said.
“We don't think there is any selective long-term decline after CABG that cannot be seen in other groups with significant coronary artery disease. We don't think late decline should be an issue in the choice of what procedure you're going to have done,” Dr. McKhann said.
The researchers have been studying the issue of neurologic outcomes following coronary surgery since 1992.
What they have found is that “If you have coronary artery disease … you're going to be lower at baseline than the heart-healthy controls but not in all cognitive domains,” he said. “In our data we think we see a relative preservation of memory and language, and decreased psychomotor and motor speed and decreased executive function,” he said.